Luteal Phase Support in Assisted Reproductive Technologies

Luteal phase support encompasses the administration of progestogens during the interval following ovulation or embryo transfer to optimise endometrial receptivity and promote embryo implantation. In assisted reproductive technologies, the protocol for luteal support varies according to the treatment modality, whether fresh or frozen embryo transfer, and may include progesterone delivered vaginally, intramuscularly, subcutaneously or orally. The underlying aim is to counteract the luteal insufficiency that arises from ovarian stimulation and to ensure circulating hormone concentrations remain within a range deemed conducive to decidualisation and early placentation. Recent advances have focused on individualising regimens through monitoring serum progesterone levels, incorporating adjunctive agents such as synthetic progestins, and exploring molecular markers of endometrial competence. Practical considerations include patient preference, cost, tolerability and safety. Understanding the pharmacokinetics of different formulations and the temporal synchronisation of the window of implantation is critical, as is defining optimal dose, route and duration of support in order to maximise ongoing pregnancy and live birth rates while minimising adverse effects.

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Luteal Phase Support in Assisted Reproductive Technologies publication trend

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Technical terms

Luteal phase support (LPS): Administration of progestogens following ovulation or embryo transfer to enhance endometrial receptivity and implantation.

Frozen embryo transfer (FET): Thawing and transfer of cryopreserved embryos into a hormonally prepared endometrium.

Hormone replacement therapy (HRT): Exogenous administration of oestrogens and progesterone to mimic natural cycles in preparation for embryo transfer.

Dydrogesterone: A synthetic progestin used orally for luteal support with a bioidentical profile to natural progesterone.

Endometrial receptivity: A time-limited state during which the endometrium is optimally primed for embryo implantation.

microRNA (miRNA): Small non-coding RNA molecules that regulate gene expression and can serve as biomarkers of endometrial status.

Serum progesterone (P4): Circulating concentration of progesterone measured to assess adequacy of luteal support.

References

1. No additional risk of congenital anomalies after first-trimester dydrogesterone use: a systematic review and meta-analysis. Human Reproduction Open (2024).
2. Rectal progesterone administration secures a high ongoing pregnancy rate in a personalized Hormone Replacement Therapy Frozen Embryo Transfer (HRT-FET) protocol: a prospective interventional study. Human Reproduction (2023).
3. Different Dosages of Progesterone in Luteal Phase Support Reflect Varying Endometrial microRNA Expression in Frozen Embryo Transfer Cycles. International Journal of Molecular Sciences (2024).